Robotic Colorectal Surgery Training


I started my robotic training in 2018 as a surgical trainee (ST7) at Sunderland Royal Hospital in the North East of England. Over the last few years I’ve learnt a huge amount as I’ve carved out my path in the field of robotic surgery. Here are my top ten tips for all surgical trainees wanting to pursue a career in robotics.

🤖 1. Good basic laparoscopic skills

Having good basic minimally invasive skills will serve you well when you come to transition your training from laparoscopic to robotic surgery. Good laparoscopic skills including psychomotor skills, spatial awareness and good tissue handling are easily applicable to the robotic setting. It is also widely accepted that laparoscopic proficiency can help flatten the robotic learning curve.

🤖 2. Robotic Mentors

A dedicated robotic mentor is an invaluable resource. Pick a mentor who is an established and accredited robotic surgeon, with a track record in training. Established robotic mentors can share a wealth of expertise with you beyond operative training, including, setting up and navigating a service, brokering relationships with industry and introductions to other robotic experts. The best mentors are generous with their knowledge, expertise and wisdom.

🤖 3. Industry Partners

At present robotic surgery training is largely driven by industry, although, this is beginning to change. Find out who your local robotic industry representative is and talk to them about the potential training opportunities available. There are many available online learning tools available through industry platforms to get you started and help you understand the essential fundamentals of robotic surgery.

Golam Farook and Deena Harji

🤖 4. Training Resources

There are a multitude of training resources available for robotic surgery outside of the theatre setting. The amazing Belgian robotic surgeon, Dr Ellen Van Eetvelde, once said, ‘you have to learn to operate with your eyes’ and I couldn’t agree more! There are a number of available platforms with high quality robotic training videos, these are well worth a look at. I would highly recommend the detailed, step-by-step procedural videos produced by Dr Mark Solimon.

There has also been a huge expansion in the availability of cadaveric and robotic simulation courses for surgical trainees over the last 12 months. I would recommend that you attend such a course when you are working in a robotic unit with appropriate surgical access as this will provide you with maximal benefit.

The European Society of Coloproctology launched their robotic colorectal surgery webinars earlier this year providing tips and tricks on a range of robotic scenarios from port placement to complete mesocolic excision. These are well worth a look.

🤖 5. Simulation

Robotic simulation is the first key step of your robotic training journey, providing you with an immersive introduction to the robotic platform. Do not underestimate the time it takes to complete all of the simulation exercises to the appropriate level. Complete these exercises in short, dedicated time blocks consisting of 60-90 minutes, after this fatigue sets in and affects your performance.

🤖 6. Robotic Test Drive

Understanding the fundamental principles of how the different components of the robotic platform work is essential. Book a robotic test drive with your industry representative or robotic trainer and go through the key features of how the platform works, including set-up and safety features.

🤖 7. Robotic Bedside Assistance

Robotic bedside assistance includes set-up, robotic docking, operative assistance, instrument exchange and adjustment of robotic arms as well as performing emergency undocking manoeuvres if required. Being an effective robotic bedside assistant provides you with key insights into the synergistic relationship between the surgeon console and the patient cart. Robotic bedside assistance will also help you develop key communication skills required between robotic assistant and console surgeon. These skills become invaluable as you progress from robotic bedside assistance to console surgeon and begin to direct your own assistant.

🤖 8. Component Learning

Break down each robotic operation into its component part following discussion with your trainer and aim to perfect each individual step. For example, low anterior resection is broken down into four key steps ; 1) lateral mobilisation, 2) IMA division, 3) TME and 4) splenic flexure mobilisation. Progress through each of these steps starting with the easiest and working towards the most complicated. Employing this approach will gradually build your confidence with the robotic platform and will help develop your operative skills.

🤖 9. Track your progress

Keep a record of all your robotic procedures including bedside assistant cases, robotic docking and operative procedures. Record all your operations and watch these back with your robotic trainer to identify keys areas for improvement. There are available platforms such as C-SATS on which you can upload your robotic videos for independent objective assessment from international robotic experts.

🤖 10. Robotic Fellowship and Opportunities

Robotic colorectal surgery is expanding in the UK and internationally, as a result, there are a number of well established, high volume dedicated robotic fellowships available. These are highly recommended to accelerate your robotic training as they provide trainer expertise, regular robotic access and volume. Keep a look out on relevant websites including the ASGBI, ESCP and ALSGBI. I can personally recommend the ESCP Robotic Fellowship at Hôpital Haut-Lévêque Groupe Hospitalier CHU Bordeaux under Professor Quentin Denost.

As robotic surgery and training continues to evolve so will the opportunities to get involved in robotic research, training and curriculum development. Make the most of these opportunities and get involved in initiatives such as the Royal College of Surgeons Robotic and Digital Surgery (RADAR) Initiative and its partnership initiative with the Association of Surgical Trainees Technology Enhanced Surgical Training.

Attendance at dedicated robotic conferences will keep you abreast of the latest developments in robotic surgery and will allow you to network with international robotic experts. The upcoming virtual Robotic Colorectal Surgery Symposium 2021 (ROCS2021) provides you with an ideal opportunity to do this. There are also a number of industry delivered symposia throughout the year, which are worth checking out.

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